<div id="gatic_login_block" style="display:none;">
    <div class="dropshadow modal" style="z-index:108;top:265px">
        <div class="contact-box">        
            <table width="100%">
                <tr>
                    <td colspan="2" align="center"><h2>My Gatic<br />
Registration request <span style="float: right;"><a href="#" id="gatic_login">X</a></span></h2></td>
                </tr>
                <tr>
                    <td valign="top" colspan="2" align="left" class="label" style="text-align:left;">Information requested by Gatic for the purposes of registration to My Gatic will be used solely for the purposes of communicating useful information to the registered member and his/her company
and not divulged or passed on to any third party for any purpose whatsoever, without the expressed permission of the registered party concerned.<br /><br />To review Gatic&#39;s Privacy Policy in full, please <a href="#">click here</a></td>
                </tr>
                <tr>
                    <td class="label">Name</td>
                    <td><input type="text" /></td>
                </tr>
                <tr>
                    <td class="label">Job Title</td>
                    <td><input type="text" /></td>
                </tr>
                <tr>
                    <td class="label">Business Type</td>
                    <td><input type="text" /></td>
                </tr>
                <tr>
                    <td class="label">Email</td>
                    <td><input type="text" /></td>
                </tr>
				<tr>
                    <td class="label">Company</td>
                    <td><input type="text" /></td>
                </tr>
				<tr>
                    <td class="label">Password</td>
                    <td><input type="text" /></td>
                </tr>
				<tr>
                    <td class="label">Confirm Password</td>
                    <td><input type="text" /></td>
                </tr>
				<tr>
                    <td class="label"><input type="submit" value="Submit" style="width:100px;" /></td>
                    <td><i>All fields are required</i></td>
                </tr>                                           
            </table>
        </div> 
    </div>
</div>